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To compare IgG anti-cyclic citrullinated peptide (CCP) enzyme-linked immunosorbent assays (ELISAs) of second (anti-CCP2) and third generations (anti-CCP3) for the diagnosis of rheumatoid arthritis (RA), an IgA CCP3 ELISA was also evaluated. Combinations of the use of the three tests were evaluated. Anti-CCP2 IgG, anti-CCP3 IgG, and anti-CCP3 IgA antibody levels were determined by ELISAs in the serum of 70 patients with rheumatoid arthritis, 34 patients with systemic lupus erythematosus (SLE), and 54 normal subjects. We evaluated the serum levels, diagnostic performance, and the use of a combination of tests for RA diagnosis. Statistical analyses include receiver operating curves (ROCs) and others. The serum levels were higher in RA patients. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (LR), and negative LR were, respectively, 78.6%, 94.3%, 91.7%, 84.7%, 13.8, and 0.23 for anti- CCP2 IgG and 82.9%, 93.2%, 90.6%, 87.2%, 12.2, and 0.18 for anti-CCP3 IgG. These values were better than the same statistical tests for anti-CCP3 IgA. ROC analysis showed that anti-CCP2 IgG and anti-CCP3 IgG had good performance and similar areas. Measuring both IgG and IgA anti-CCP tests increases the specificity if both tests were positive and increases the sensitivity if either test were positive. In our population, anti-CCP2 IgG and anti-CCP3 IgG had good diagnostic performance. Anti-CCP3 IgG had 4.3% more sensitivity than the anti-CCP2 IgG test while sustaining high specificity. This and other studies suggest the development of a dual test--CCP3 IgG and IgA that may be a potential diagnostic tool.

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The 4th ANA Consensus included three novel patterns into the existing algorithm (cytoplasmic Rods and Rings, nuclear Quasi-homogeneous, and CENP-F). Emphasis was given to the need of attention in describing the peculiar mixed pattern elicited by anti-DNA topoisomerase I (Scl-70) autoantibodies, comprising nuclear fine specked, nucleolar homogeneous pattern, NOR staining in metaphase plates, and cytoplasmic fine speckled patterns. The group also emphasized the need for continuous quality control in indirect immunofluorescence assays, the establishment of screening dilutions, as well as conjugate titration. An alert was made regarding the heterogeneity of commercial kits in defining patterns and the use of solid phase methodologies to determine the presence of autoantibodies.

Background The VI Brazilian Consensus on Autoantibodies against HEp-2 cells for determination of autoantibodies against cellular constituents on HEp-2 cells was held on September, 2019, in Fortaleza (CE, Brazil). The guidelines in this edition were formulated by the group of Brazilian experts discussing the classification of complex patterns, the classification of the nuclear discrete dots (few and multiple), the identification of the discrete fine speckled pattern (AC-4a) and improvements on the ANA report. Mainbody Sixteen Brazilian researchers and experts from universities and clinical laboratories representing the various geographical regions of Brazil participated in the meeting. Four main topics were discussed: (1) How to classify patterns with fluorescence in more than one cell compartment considering three relevant categoris: composite patterns, mixed patterns and multiple patterns; (2) The splitting of the discrete nuclear dots pattern into the multiple discrete nuclear dots (AC-6) and few discrete nuclear dots (AC-7) patterns, respectively; (3) Inclusion of a novel nuclear pattern characterized by discrete fine speckled pattern highly associated with antibodies to SS-A/Ro60, classified as AC-4a. In addition, adjustments on the Brazilian Consensus nomenclature were implemented aiming to harmonize the designation of some patterns with the International Consensus on ANA Patterns (ICAP). Furthermore, the designations of the PCNA-like pattern (AC-13), CENP-F-like pattern (AC-14) and Topo I-like pattern (AC-29) were adjusted in accordance to ICAP. Finally, there was a recommendation for adjustment in the test report in order to address the status of nuclear envelope staining. For all topics, the aim was to establish specific guidelines for laboratories and clinicians. All recommendations were based on consensus among participants. All recommendations from the V Consensus were maintained and there was relevant progress in the BCA/HEp-2 guidelines and further harmonization with ICAP. Conclusion The VI BCA/HEp-2 edition was successful in establishing important recommendations regarding the classification of complex patterns, in supporting the identification of a novel pattern within the AC-4 group and in the harmonization process with the ICAP terminology.

BackgroundNon-alcoholic fatty liver disease (NAFLD) affects 20–30% of general population and a wide range of 14–59% patients with cutaneous psoriasis (PsO). Psoriatic arthritis (PsA) has been linked to comorbidities including diabetes, arterial hypertension, dyslipidemia and metabolic syndrome (MetS) though data on NAFLD in PsA is lacking. In fact, in PsA, NAFLD has been evaluatedin only one Italian study affecting 28% patients.ObjectivesTo evaluate the prevalence of NAFLD in our cohort of patients with PsA.MethodsAll patients with PsA regularly followed-up during a 6 month period at our outpatient rheumatology clinic were studied. They were evaluated byabdominal ultrasound (US) and NAFLD was defined in the presence of hepatic steatosis (US = Grades I to III).The occurrence of associated comorbidities, includingarterial hypertension, diabetes and dyslipidemia was recorded and the NCEP-ACT III criteria were applied to identify subjects with metabolic syndrome (MetS). DAS 28, BASDAI and ASDAS were used to assess PsA disease activity, while HAQ was performed to assess functional impairment. Student's t, Chi-square and Fisher's exact tests were performed for statistical analyses and P values ≤0.05 were considered significant.ResultsFifty six PsA patients were initially enrolled, but 3 were excluded due to the presence of alcoholic cirrhosis in 2 and a positive serology for hepatitis C in 1. Among the remaining 53 patients, 26 were males and 27 females, with mean age = 54,8±13 yrs (27–76) and mean disease duration = 14,4±8,1 yrs (04–40). US revealed NAFLD in 33/53 (63%) patients with PsA, confirmed by liver biopsy in 2. Arterial hypertension, diabetes and dyslipidemia affected 81%, 42%, 75% of patients with NAFLD respectively (P<0.001). MetS was present in 58,5% (31/53) individuals, significantly more prevalent in patients with compared to those without NAFLD: 26/33 (78.8%) vs. 05/20 (25.0%), P<0.001, despite of gender. All disease activity indices (% patients with DAS28>2.6), mean BASDAI and mean ASDAS) and HAQ scores were similar among patients with or without NAFLD (55.6% vs 46.7%; 3.1 vs 3.7; 1.9 vs 2.3; 1 vs 0.9 respectively, P>0.05).ConclusionsNAFLD is very common in our cohort of PsA patients occurring in over 2/3 regardless of disease activity and associated to MetS in most subjects, suggesting a relationship between these conditions. Moreover, screening for NAFLD inPsA patients is warranted in order to avoid increased overall liver morbidity.ReferencesPsoriatic arthritis: a systematic review, International Journal of Rheumatic Diseases 2010; 13: 300–317.Wenck et al. Journal of the European Academy of Dermatology, 2011.Candia et al. Journal of the European Academy of Dermatology, 2015.Di Minno et al. Arthritis Research & Therapy, 2012.Disclosure of InterestNone declared

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